Hip fracture surgery outcomes in skilled nursing and rehabilitation facilities are tied to the patient’s length of stay, according to a new study of fee-for-service care.

Investigators analyzed outcomes in hip fracture surgery patients from four U.S. rehabilitation facilities and seven skilled nursing facilities. The patients had Medicare fee-for-service as their primary payer. Rate of recovery and length of stay were associated with mobility and self-care outcomes at discharge following the surgery.

The findings suggest that some patients, particularly those with medium functional gains, may not reach their full recovery potential if their length of stay is less than 21 days. This is because they will typically achieve functional independence at around 28 days in rehabilitation, said Trudy Mallinson, Ph.D., of George Washington University.

In those cases, earlier discharge means that the patient’s burden of care is transferred to family and caregivers, home health, and outpatient services, Mallinson said. Care teams should therefore identify a patient’s recovery trajectory “early enough in care to promote the best possible outcomes and allocate resources efficiently,” the authors concluded.

“The inclination is typically to give a patient more therapy per day,” added Mallinson.  “… But perhaps more isn’t always the right thing to do. Maybe a longer stay is the right thing for some patients.”

The study was published in JAMA Network Open.